Urology
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Both pre- and postnephrectomy levels of serum creatinine were measured in 52 consecutive patients who underwent radical nephrectomy for localized renal cell carcinoma between 1971 and 1976. At the time of follow-up, 17 patients were alive and 35 had died, 14 of renal cell carcinoma and 21 of other causes. Follow-up lasted a minimum of 115.5 months (mean 151.1 months, median 141.1, range 115.5-211.3 months) for 16 of the 17 patients who were alive. ⋯ The patient whose value was 2.4 mg/dL was a diabetic who required insulin. No serious renal failure, renal disease, or tumors in the contralateral kidney occurred among the total group of 52 patients. These data indicate that renal function remains adequate in patients who have a normal contralateral kidney and are treated by radical nephrectomy.
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In the last fifteen months we have used continuous postoperative epidural analgesia after open urologic surgery and herein report our experience with the first 64 patients. Incisional pain was completely eliminated in 96 percent of patients. Epidural analgesia diminished pain-related pulmonary complications without sedation. ⋯ Hypotension due to sympathetic blockade responds to intravenous fluid administration. Urinary retention is avoidable if the epidural infusion is discontinued prior to removing the urethral catheter. Itching is an undesirable consequence observed by 20 percent of patients when morphine is used.
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We report a case of splenic abscess as a complication of percutaneous nephrostomy tube placement. The patient was a sixty-three-year-old man suffering from a recurrence of transitional cell carcinoma of the bladder after cystectomy and neobladder substitution. ⋯ The patient's condition improved dramatically, and computed tomography showed complete resolution of the abscess two weeks after drainage. Splenic abscess is fatal if untreated and should be considered in a patient in whom sepsis or left lower pulmonary effusion develops after percutaneous manipulation of the kidney.
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TRUS allows visualization of the internal anatomy of the prostate gland. Knowledge of zonal prostate anatomy allows more accurate staging of prostate cancer by use of strategic TRUS-guided biopsy of sites of possible tumor extension. ⋯ TRUS can detect nonpalpable tumors with average dimensions as small as 1.0 cm. This size is considered to be clinically significant.
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A group of 218 men complaining of symptoms of chronic prostatitis were identified. Symptoms included pelvic and genital pain with or without voiding or ejaculation, urinary frequency and/or urgency, and often a thin watery urethral discharge. ⋯ With nothing but stress management therapy 110 patients (86%) reported that they were "better," "much better," or "cured." Physiologically, the therapy makes sound medical sense. It is suggested that the term "stress prostatitis" is an appropriate label for this condition.